Paraphilia and abuse-martyrdom: exhibitionism as a paradigm for reciprocal couple counseling combined with antiandrogen.

A paraphiliac with syndrome of exhibitionism has received treatment with the anti-androgenic hormone, Depo-Provera, for three years and is maintained on 350 mg, intramuscularly each week. He and his wife had been in a pathological oppressor/martyr relationship, he as a paraphiliac-oppressor and she as an abuse-martyr. They both receive reciprocal counseling therapy in individual and couple sessions. Antiandrogen diminishes paraphilic fantasy and enhances self-governance of its behavioral concomitants, but does not totally suppress erotosexual expression. Reciprocal counseling therapy enhances erotosexuality and pair-bondedness between the two partners as they both change, not singly, but mutually, toward a more healthy life style.